Key result
Appropriate pacemaker selection occurs in only ~64% of real-world patients, with frequent underutilization of settings.
Cross-Sectional (n=1,858)
Yes
A significant proportion of patients do not receive optimal pacemaker hardware or appropriate programming for their underlying rhythm disorder, highlighting a gap in translating device capabilities to real-world clinical care.
Exposes gaps in real-world pacemaker selection and programming; hypothesis-generating for quality initiatives without changing practice.
AIM: The aim of this multicentre, observational, transversal study was to evaluate pacemaker (PM) choice and setting in a large number of patients, in order to understand their relationship with the patients' clinical characteristics. METHODS AND RESULTS: The study enrolled a total of 1858 patients (71 ± 14 years, 54% male), consecutively evaluated during scheduled PM follow-up visits in 7 Italian cardiac arrhythmia centres. To evaluate the appropriateness of PM choice in relation to the patients' clinical characteristics, we analysed their rhythm disorders at the time of device implantation and the characteristics of the devices implanted. To evaluate the appropriateness of device setting, current rhythm disorders and device setting at the time of enrolment were analysed. In the overall study population, 64.3% of the patients received a PM with all of the features required for their rhythm disorder [80.8% in persistent atrioventricular (AV) block, 76.5% in atrial fibrillation needing pacing, 71.0% in sinus node disease, 58.7% in non-persistent atrioventricular block (AVB), 52.7% in neuro-mediated syncope]. The most frequent cause of inappropriate PM choice was the lack of an algorithm to promote intrinsic AV conduction in non-persistent AVB patients (38.1%). In 76.2% of the patients with an appropriate PM (n = 1301), the PM was optimally set for their rhythm disorder. CONCLUSIONS: In the present 'real-world' registry, a large number of patients (35.7%) did not receive an optimal PM for their rhythm disorders. Moreover, one-fourth of appropriate PMs were not programmed according to the patients' clinical characteristics.
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Ziacchi et al. (2016) conducted a cross-sectional in bradyarrhythmia requiring a pacemaker (n=1,858). Pacemaker choice and programming was evaluated on Appropriateness of pacemaker choice according to the patient's rhythm disorder at time of device implantation. In a real-world registry, 64.3% of patients received a pacemaker endowed with all features appropriate for their rhythm disorder, and among these, only 76.2% had appropriate device settings activated.
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